The purpose of this research is to determine the impact of an extremely low-cost institutional change in medical practice on the rates of identification and intervention with patients who smoke. This innovative institutional change is the expansion of the vital signs to include smoking status as the New Vital Sign. Cigarette smoking remains the chief avoidable cause of illness and death in our society, responsible for 20% of all deaths (434,000/year) and more than $50 billion in additional health care costs per year. Recent surveys report that more than 70% of smokers want to quit and have made at least one serious quit attempt. Moreover, they report that advice from a clinician is one of the most important motivators to make a quit attempt. About 70% of smokers see a physician each year, making clinicians uniquely positioned to intervene with patients who smoke. Unfortunately, many clinicians are not utilizing this opportunity. Approximately 50% of patients who smoke report that their physician has never asked them if they smoke; less than 10% report that their physician provided them with specific advice on how to quit successfully. Training physicians has been of only modest success in improving this discouraging statistic and is often difficult and expensive to implement. The proposed research builds upon pilot data showing that a simple institutional change --making smoking status part of the vital signs -- markedly enhances the rate of identification of patients who smoke. This change was also associated with a higher rate of clinician intervention with patients who smoke. The proposed research will expand the vital sign intervention to include an appropriate control group and more clinics to assess the generalizability of this extremely low-cost institutional change. Moreover, the research will assess the impact of an additional simple intervention - providing all smokers with a self-help booklet. Finally, we will follow patients who smoke for one year to assess rates of smoking cessation attempts and success. This will address a fundamental question -- does the expansion of the vital signs to include smoking status also lead to more quitting? After a usual care baseline assessment period, six clinics in Madison, WI, will be randomly assigned to either a usual care control group, the Vital Sign intervention group, or the Vital Sign intervention plus self-help booklets for smokers. The Vital Sign intervention consists of printing all progress note paper with a vital sign stamp that includes smoking status. The major endpoints will be 1) the rates of identification of patients who smoke, 2) rates of intervention by the clinician with patients who smoke, 3) rates of smoking cessation attempts at one year, and 4) rates of smoking cessation success at one year.